Prevalence, Risk Factors, and Clinical Relevance of Fluoroquinolone-Resistant Organisms in Rectal Cultures: Should We Target Antibiotic Prophylaxis Prior to Prostate Biopsy?

The rise of infectious complications after prostate biopsy has been linked to the growing resistance of enterobacteria to fluoroquinolone (FQ) antibiotics. In this review, we investigated the potential benefit of targeted antibiotic prophylaxis based on rectal cultures prior to prostate biopsy. An electronic search for all related literature published in English was performed from April until June 2015 using the MEDLINE and EMBASE databases. Data were obtained regarding the true prevalence of FQ-resistant bacteria in the rectum of patients, the identification of those patients at risk of harbouring FQ-resistant bacteria, the risk of infectious complications after transrectal prostate biopsy in patients with FQ-resistant bacteria, and the effect of targeted prophylaxis. Although there is limited evidence that a targeted approach might be beneficial, we conclude that current studies on the use of rectal cultures in the prebiopsy setting have too many limitations and confounding variables to definitely accept this approach in clinical practice. Whether this methodology is useful in a certain region will greatly depend on local fluoroquinolone-resistance rates.

[A woman with a swelling in the groin]. / Een vrouw met een zwelling in de lies.

A 75-years-old woman presented to the Emergency Department with a painfull swelling in the right groin. Clinical examination was suggestive of an incarcerated hernia. Echography and examination during surgery revealed an Amyand's hernia. Amyand's hernia is a rare type of a sliding hernia that is characterized bij protrusion of the appendix in the hernial sac. Surgical reduction of the hernial sac was followed by appendectomy because the appendix was inflamed: a rare complication of Amyand's hernia.